Identifying indicators of potentially hazardous prescribing related to mental health disorders and medications: A systematic review

Wael Khawagi, Douglas Steinke, Joanne Nguyen, Richard Keers

Research output: Contribution to journalMeeting Abstractpeer-review


Background: Measuring the safety of prescribing is vital to understanding and improving patient care. As a result, several sets of hazardous prescribing indicators and criteria have been developed for use across primary and secondary care settings. Despite the fact that prescribing errors and medication‐related harm may be common in patients with mental illness, there has been limited research focusing on the development and application of potentially hazardous prescribing indicators, known as prescribing safety indicators (PSIs), specifically for this unique patient group.

Aim: Identify existing indicators of potentially hazardous prescribing related to mental health (MH) medications and conditions from the published literature.

Methods: A systematic search was conducted using seven electronic databases: Embase, MEDLINE, PsycINFO, Web of Science, HMIC, IPA, and CINAHL (from 1990 to November 2017). The bibliographies of included studies and of relevant review articles were reviewed for additional studies. Citation screening followed three phases; first, studies which developed, validated or updated a set of explicit medication‐specific indicators or criteria that measured prescribing in terms of safety or quality were eligible for inclusion, irrespective of whether they contained MH indicators or not. Second, relevant articles underwent further screening to extract any MH‐related indicators (quality or safety), which was determined based on our operational definition. Finally, two expert MH clinical pharmacists screened the identified MH indicators and selected PSIs that described potentially hazardous prescribing that could cause significant risk of harm. These PSIs were categorised into seven prescribing problems and nine medication categories.

Results: Seventy‐six unique studies were included, 67 of which contained at least one MH‐related indicator along with five that specifically focused on indicators for populations with mental illness. Among the 67 studies containing MH indicators, the elderly population was the most commonly targeted (n = 36, 53.7%), and the most common method for indicators validation was the Delphi method (n = 32, 47.8%). A total of 1262 MH prescribing indicators were identified, with an average of 18 (SD = 24.7) per study (range 1–127); 245 of these were considered PSIs. Among the identified PSIs, the most common type of prescribing problem was “Potentially inappropriate prescribing considering diagnoses or conditions” (n = 106, 43.3%), and the lowest was “omission” (n = 6, 2.4%). “Antidepressant” was the most common medication category (n = 85, 34.7%) and “non‐specific psychotropics” was the lowest (n = 1, 0.4%).

Conclusion: This is the first systematic review to identify a comprehensive list of MH‐related indicators of potentially hazardous prescribing. Examination of the types of indicators reported has revealed important targets for new PSIs and will inform the development of a new expanded suite of PSIs applicable to patients with mental illness.
Original languageEnglish
Pages (from-to)5
JournalPharmacoepidemiology and Drug Safety
Publication statusPublished - 10 Feb 2019
EventPrescribing and Research in Medicines Management (UK & Ireland) PRIMM Annual Conference: Person-centred Care in the Digital Age: Nudge, Nudge, Tweet, Tweet - NCVO, Society Building, London, United Kingdom
Duration: 14 Dec 201814 Dec 2018
Conference number: 30th Annual Scientific Meeting


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